Guidelines for Pradhan Mantri Arogya Mitra (PMAM) - AYUSHMAN BHARAT - PRADHAN MANTRI JAN AROGYA YOJANA (AB PM-JAY)
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Guidelines for
Pradhan Mantri
Arogya Mitra (PMAM)
AYUSHMAN BHARAT – PRADHAN
MANTRI JAN AROGYA YOJANA (AB
PM-JAY)
Guidelines for PMAMs
FOREWORD
National Health Authority
Ministry of Health and Family Welfare
Government of India
Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) endeavours to offer secondary and
tertiary health coverage of Rs. 5,00,000 (per family) to more than 10 crore beneficiary families, accounting
for more than 40 percent of India’s population at empanelled hospitals. This unprecedented effort of the
Government of India is likely to have a significant positive impact on the poor and vulnerable population’s
access to high quality healthcare.
Dr. Indu Bhushan
Chief Executive Officer
National Health Authority
Page 1 of 12Guidelines for PMAMs
Table of Contents
ACRONYMS 3
INTRODUCTION 4
CRITERIA FOR SELECTION OF PRADHAN M ANTRI AROGYA MITRA 4
RECRUITMENT OF PRADHAN M ANTRI AROGYA MITRA 5
PLACEMENT OF PRADHAN MANTRI AROGYA MITRA 5
ROLES AND RESPONSIBILITIES 6
HELP DESK/ KIOSK 9
TRAINING OF PRADHAN M ANTRI AROGYA MITRA 9
BENEFITS TO PRADHAN M ANTRI AROGYA MITRA 10
TERM OF PRADHAN M ANTRI AROGYA MITRA 10
Page 2 of 12Guidelines for PMAMs
Acronyms
a) AB PM-JAY: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna
b) ASHA: Accredited Social Health Activist
c) BIS: Beneficiary Identification System
d) EHCP: Empanelled Health Care Provider
e) IC: Insurance Company
f) ISA: Implementation Support Agency
g) NHA: National Health Authority
h) PMAM: Pradhan Mantri Arogya Mitra
i) SHA: State Health Agency
j) UTs: Union Territories
Page 3 of 12Guidelines for PMAMs
Introduction
It is critical to establish a system lead by Pradhan Mantri Arogya Mitra (PMAM) for assisting beneficiaries
at Empanelled Health Care Provider (EHCP). Thus, to streamline the health service delivery and provide
a seamless experience to the beneficiary, a Pradhan Mantri Arogya Mitra is placed at each EHCP. A
Pradhan Mantri Arogya Mitra is a certified frontline health service professional who shall be present at each
of the EHCP and shall serve as a first contact point for beneficiaries.
Criteria for Selection of Pradhan Mantri Arogya Mitra
The Pradhan Mantri Arogya Mitras (PMAMs) will be selected based on the following criteria:
a) Completed 10+2 from a recognized institution (Preferably Graduate)
b) Basic proficiency in computer operations
c) Completed the Pradhan Mantri Arogya Mitra Training Course and passed the respective course
exam/certification.
d) Possessing fluent communication skills in Hindi/ English and Local language of the State/ region
e) Having adequate functional computer literacy which shall include understanding of Microsoft Office
Suite and navigating through Internet Portals.
Preference to be given to Female Candidates for the position of Pradhan Mantri Arogya Mitra. Qualified
ASHA workers may be given preference for the position of PMAM (if interested).
Existing staff of Government hospitals can also be nominated to act as Pradhan Mantri Arogya Mitra by
the State Government.
Page 4 of 12Guidelines for PMAMs
Recruitment of Pradhan Mantri Arogya Mitra
a) The State Health Agency (SHA)/Hospitals will have the flexibility to recruit PMAM through third-
party agency/agencies or through any other mechanism for public facilities. Based on the number
of PMAMs required, the SHA shall pay them through a third-party agency / agencies/hospital or
any other mechanism. In case of requirement of extra PMAMs, the SHA/Selected Agency/Hospital
should have the capability to promptly scale up its capacity and provide the required number of
PMAMs.
b) SHA can directly hire PMAMs at State/ District or hospital level.
c) If the State Government requires, they can even nominate existing staff of public hospitals as
PMAMs.
d) For Private EHCP, the recruitment and placement of PMAM should be done by the health care
provider itself. The cost of the PMAM in that facility should be borne by the Private EHCP.
e) The monthly remuneration of PMAMs including fixed component and incentives (if any) should not
be less than the minimum wages in the State as prescribed by the Minimum Wages Act.
Placement of Pradhan Mantri Arogya Mitra
PMAMs will be placed at every public and private EHCP. The exact numbers of PMAMs to be placed shall
be dependent on the average case-load per day. A suggestive placement of PMAMs based on cases
registered per day is given below.
a) 0-10 Cases – 1 PMAM
b) 10-20 Cases – 2 PMAMs
c) 20-30 Cases – 3 PMAMs
d) 30-40 Cases – 4 PMAMs
The State or EHCP can revise the number of PMAMs based on local conditions, however, they will ensure
that services are available to the beneficiaries 24x7 in the hospital.
Page 5 of 12Guidelines for PMAMs
After the initial placement, State Government may also consider to shuffle PMAMs every 6/12 months
within the same city /town. The reshuffling of PMAMs (if required) shall be done by the district nodal officer
either directly or through selected agency.
Roles and Responsibilities
PMAM plays three main roles under AB PM-JAY. First as a Trusted Partner of Beneficiaries, then as a
Representative of Authorities and finally as a System Operator. The PMAM is the primary contact for the
beneficiaries at every EHCP.
The PMAM shall be responsible for the following broad areas:
a) Guiding the Beneficiary about the overall benefits under AB PM-JAY and providing information
about receiving prompt treatment at EHCP
b) Operating the Beneficiary Identification System to identify and verify the beneficiaries entitled
under AB PM-JAY
c) Operating the Transaction Management System such as submitting requests for Pre-
Authorization, Updating Surgery/Treatment Details and Filing for Claims
d) Ensure the privacy and confidentiality of personal and sensitive beneficiary information is
maintained while operating IT systems under AB PM-JAY
For ensuring timely access to medical care, PMAM is responsible for operating the Beneficiary Identification
System (BIS) to identify, authenticate and verify the beneficiaries entitled under the AB PM-JAY.
Page 6 of 12Guidelines for PMAMs
Figure 1: Role of Pradhan Mantri Arogya Mitra in operating the BIS System for a New
Beneficiary
The PMAM shall work on the BIS as per the process mentioned below.
a) PMAM receives the potential Beneficiary visiting an EHCP at the designated Arogya Mitra Sahayta
Kendra
b) PMAM collects the AADHAAR Card, Family ID Card or any other Government ID Card from the
beneficiary.
c) PMAM searches the beneficiary name/family using different search parameters on BIS
d) On identification of beneficiary name in database, PMAM proceeds for beneficiary authentication
through individual verification
e) PMAM either does online verification using Aadhaar or enter details in case of Non-AADHAAR
document and validate beneficiary mobile number. In cases of Non-AADHAAR verification, a
digital photo of the beneficiary is also taken by the PMAM
f) Post individual verification, PMAM uploads the family documents submitted by the beneficiary for
establishing the beneficiary relation with the entitled family.
g) The PMAM, after uploading Individual ID and Family ID submits the record to the Approving
Authorities for further verification and approval. Such a record gets inserted into the database as
a “Silver Record”.
Page 7 of 12Guidelines for PMAMs
h) A Silver Record once approved by the Approving Authority is called “Golden Record”. The
tentative time required for approval of a Silver Record by the Approving Authorities is 30 minutes.
i) PMAM will then print the “Golden Record” and hand it over to the beneficiary.
Figure 2: Role of Pradhan Mantri Arogya Mitra when a Beneficiary visits an empanelled health
care facility
Along with ensuring a systematic operation of BIS, the PMAM is also responsible for the following duties:
a) To provide all the necessary assistance and details about the scheme to the beneficiaries.
i. In case of OPD: If the ailment does not require hospitalization, PMAMs will have to
explain to the beneficiary that the AB PM-JAY Golden card does not cover the OPD
treatment and hence any cost incurred for treatment under OPD will be necessarily
borne by the patient.
b) To collect, scan and upload all the necessary documents required for submitting the request for
pre-authorization, updating surgery/treatment details, updating discharge/death summary and
filing of claims.
c) To ensure that the patient, from the time of pre-authorization to discharge, is getting all the benefits
as per AB PM-JAY norms.
d) To liaison with the EHCP for timely admission and availability of bed to patient.
e) To help locate facilities and guide a patient in receiving prompt treatment.
f) To liaison and coordinate with the Medical officer for collecting, scanning and uploading all the
necessary documents required for submitting claim request.
g) To ensure that all the facilities that the AB PM-JAY beneficiaries requires are being rendered
without charging any amount.
Page 8 of 12Guidelines for PMAMs
h) To verify discharge summary and follow-up details to the discharged beneficiaries.
i) In an unlikely scenario of Golden Record being lost or damaged, PMAM is to guide and provide
the cardholder for obtaining a copy of the Golden Record.
j) To immediately bring all grievances to the notice of Grievance Cell directly or through District
Coordinator or by uploading grievances on the Central Grievance Redressal Management Portal.
k) To facilitate the hospital in giving prior phone intimation to the concerned authority for carrying out
the emergency surgeries.
l) To track and report refund of any investigation amount collected in contravention to the Scheme
Guidelines
m) To report any irregularities or inadequacy noticed to the concerned supervisors.
Thus, to ensure that PMAMs fulfil the responsibilities in an efficient manner, it is important to have a
comprehensive monitoring mechanism. The SHA/Agency (if hired)/Hospitals shall be responsible for
monitoring the performance of PMAMs. The monitoring of PMAMs shall include the following parameters.
a) Tracking Biometric Attendance of PMAMs on a daily/weekly basis
b) Tracking the number of returns for the Pre-Authorization Requests submitted
c) Evaluating the percentage of complete Pre-Authorization Requests at first instance
d) Assessing performance in Periodic Trainings
e) Analysing Beneficiary Feedback in terms of score rating and qualitative questionnaire
f) Evaluating the performance reviews submitted by District Coordinators and Senior PMAMs
g) To conduct refresher training of the PMAMs ensuring they are aware of any changes in their role
Help Desk/ Kiosk/Arogya Mitra Sahayta Kendra
a) A help desk/ kiosk/Arogya Mitra Sahayta Kendra will need to be mandatorily set up by each EHCP.
This is mainly to assist an AB PM-JAY beneficiary in completing required formalities & obtain
treatment as also assist hospitals by facilitating beneficiary identification and verification, selection
of packages, and seeking authorizations whenever required. The help desk/kiosk/Arogya Mitra
Sahayta Kendra will be designed and branded as per the IEC guidelines of NHA.
b) The EHCP should establish this help desk/ Kiosk/Arogya Mitra Sahayta Kendra near the reception
of the Hospital for easy access of the beneficiaries. PMAMs should ensure that they have access
Page 9 of 12Guidelines for PMAMs
to use infrastructure and necessary hardware such as PC, Printer, Scanner, Digital Camera,
Webcam, QR code Reader, Stationery etc.
c) The EHCP shall provide preferably a dedicated 2 Mbps or higher broadband connectivity to the
computer to be exclusively used by the PMAM.
d) A standard uniform shall also be provided to the PMAM so that they are identified easily by the
beneficiaries in the hospital. The uniform design can be downloaded from www.pmjay.gov.in
Training of Pradhan Mantri Arogya Mitra
Each Arogya Mitra will be trained in all aspects of their roles and responsibilities. Training will use both
face-to-face as well as online modes. Post training, eligible PMAMs would take up tests and would receive
a certificate on successful completion of the test.
Benefits to Pradhan Mantri Arogya Mitra
A. For Public Hospitals
For all the PMAMs working in public facilities, benefits shall be paid by the SHA/Agency (if
hired)/Hospital. The suggested benefits for the PMAM can be done in two ways:
a) A fixed honorarium with case-based incentive (overall amount should not be less than minimum
wages of the State) OR
b) A fixed remuneration per month (overall amount should not be less than minimum wages of the
State)
The monthly remuneration of PMAMs including fixed component and incentives (if any) should not
be less than the minimum wages in the State as prescribed by the Minimum Wages Act. Honorarium/
salary can be paid from the Rogi Kalyan Samiti from the funds generated through AB PM-JAY.
State may also revise the suggested benefits to PMAM, based on local conditions.
Page 10 of 12Guidelines for PMAMs
B. For Private Hospitals
For all the PMAMs working in Private EHCP, benefits shall be paid by the Private EHCP itself. The
nature of benefits should be decided by the Private EHCP. The monthly remuneration of PMAMs
including fixed component and incentives (if any) should not be less than the minimum wages in the
State as prescribed by the Minimum Wages Act
Terms of engagement of Pradhan Mantri Arogya Mitra
An Arogya Mitra may be hired initially for a period of one year and his/ her contract can be renewed
yearly based on the performance.
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